FOR ADDITIONAL DETAILS, SEE THE AAFP'S CLINICAL PREVENTIVE SERVICES RECOMMENDATIONS HERE
Abbreviations list:
USPSTF = United States Preventative Services Task Force
AAFP = American Academy of Family Physicians
AAP= American Academy of Pediatrics
ACE = American College of Endocrinology
ASCVD = Atherosclerotic Cardiovascular Disease
JAMA = Journal of the American Medical Association
OGTT = Oral Glucose Tolerance Test
PREVENTION SCREENING RECOMMENDATIONS - MOST COMMONLY USED, IN ALPHABETICAL ORDER (SOURCES: AAFP, USPSTF, CDC)
ABDOMINAL AORTIC ANEURYSM
(ballooning of the main artery supplying the abdomen and legs)
- How is this accomplished? An ultrasound is used to measure the diameter of the artery
POSITIVE RESULT: 50% larger than expected for age and sex. Most commonly, below the kidneys at ≥ 3.0cm diameter.
- Who is this screening for? Men ages 65-75 who have ever smoked in their lifetime. This is a one-time screen (if normal, not repeated)
ALCOHOL USE DISORDER - Unhealthy use in Adolescents and Adults
- How is this accomplished? Screening surveys - such as this one, found HERE.
POSITIVE RESULT: Score of 8 or higher, however guidance is recommended based on specific questions/answers
- Who is this screening for? All persons, ages 11 and up
1)Female Breast, 2)Prostate, 3)Lung, 4)Colorectal, 5)Uterine, 6)Melanoma, 7)Urinary/Bladder, 8)Non-Hodgkin Lymphoma, 9)Kidney, 10)Leukemias
1.Lung, 2.Female Breast, 3.Prostate, 4.Colorectal 5.Pancreatic, 6.Liver/Bile Duct, 7.Ovarian, 8.Leukemia, 9.Uterine, 10.Non-Hodgkin Lymphoma
--> Routine breast self-exams are NOT recommended (high false-positive rate)
--> Risk-Reducing medications (estrogen blockers) are to be offered for women ages 35+ who are at increased risk of breast cancer
CERVICAL CANCER - decreasing in the USA, as of 2015 down to 2.3 deaths per 100,000 persons
--> WHEN TO SCREEN: Starting at age 21
--> Cervical Cytology (Speculum Exam or "PAP" test) recommended every 3 years ages 21-29
--> Pap every 3 years ages 30-65 years, OR Pap + high-risk HPV virus testing every 5 years
--> Screening is NOT recommended for: age<21, age>65, or in women with hysterectomy but NO history of high-grade precancerous lesions.
COLON (COLORECTAL) CANCER - 3rd leading cause of cancer death in men and women, usually diagnosed ages 65-74.
***Currently 31.2% of adults are NOT up to date with screening!
--> WHEN TO SCREEN: Starting at age 45 (or 10 years prior to diagnosis in a first-degree relative)
--> GOLD STANDARD = colonoscopy screening (every 10 years unless otherwise specified)
--> Other Options:
-----> Cologard (DNA-FIT testing) every 1-3 years
-----> High-Sensitivity Guaiac Fecal Occult Blood Test (HSgFOBT) or Fecal Immunochemical Test (FIT) every year
-----> Flexible Sigmoidoscopy every 5 years (or every 10 years when added with FIT test)
-----> CT colonography every 5 years
--> Use of Aspirin for colorectal cancer prevention is not recommended (multiple studies show no net benefit)
LUNG CANCER - 2nd most diagnosed cancer, currently the leading cause of cancer death. Most important risk factor: SMOKING (any type) which accounts for 90% of all new diagnoses. Average age at diagnosis: 70 years
--> WHEN TO SCREEN: Age 50 (in smokers who have smoked 20-pack years*)
--> Annually screen ages 50-80 with 20-pack year history (stops early when a person has been smoke-free for 15 years)
*20-pack years means 1 pack per day for 20 years, 2 packs a day for 10 years, 1/2 pack per day for 40 years, etc.
ORAL & PHARYNGEAL CANCER (lip, mouth, nose, throat)
--> Biggest risk factors: Tobacco and alcohol use - these are declining over time
--> Other risk factors: HPV (usually from oral sex) - this is a rising risk factor
--> Inadequate evidence that screening for oral cancer improves lifespan or changes quality of life (need better methods to detect)
OVARIAN CANCER - 5th most common cause of cancer deaths among women (over 95% ages 45+, avg age 63)
--> CA-125 blood test has a low positive predictive value (positive test = more likely to NOT have ovarian cancer than have ovarian cancer)
--> Transvaginal Ultrasound can detect between 80-100% of ovarian cancers, however it is too difficult to determine cancer vs cysts or endometriosis
--> HIGH RISK INDIVIDUALS - especially BRCA 1 or 2 genetic mutation with high-risk family history (or Lynch syndrome) = screening recommended starting at age 30 (earlier in some cases) using both ultrasound AND CA-125 testing.
PANCREATIC CANCER - uncommon cancer, however this is the 3rd most common cause of cancer death in the USA.
--> Screening is NOT recommended for the general population
--> High risk individuals (family history, heredetary pancreatitis, Peutz-Jeghers syndrome, Lynch syndrome) may undergo CT, MRI, or esophageal ultrasound
--> CA 19.9 biomarker (blood test) may be useful in high-risk individuals, but has a high false-positive rate (positive result, but no cancer present)
PROSTATE CANCER - common cancer in men. 33% of men age 70's have it (11% of men diagnosed in their lifetime, 2.5% overall risk of death)
--> Large majority of prostate cancer is non-invasive and not related to death in most cases
--> AAFP does not recommend PSA testing OR rectal exam (see THIS video about PSA testing)
--> The good: PSA testing prevents approximately 1.3 deaths per 1,000 individuals over a 13 year-span
--> The bad: A high false-positive rate (abnormal finding but no cancer) often leads to unnecessary biopsies, chronic pain, impotence, and other problems
--> The Ugly: Overdiagnosis leads to more surgeries/treatments that may cause erectile dysfunction, incontinence, chronic pain, and depression.
--> Most prostate cancers require no intervention
--> FALSE POSITIVE RATE: 15% of men over the course of a 10-year span of surveillance
SKIN CANCER - melanoma, squamous cell, and basal cell cancers.
--> Current recommendation by USPSTF: evidence is insufficient and balance of benefit vs harm cannot be determined (screening not defined)
--> Visual detection by clnicians is currently recommended (See ABCDE rule HERE). Concerns exist regarding excessive biopsies.
--> Virtue Medical does recommend skin exams - particularly in those with excessive sunlight exposure history.
--> Dermatology evaluation is recommended in any case of abnormal skin findings or where a concern about skin cancer exists.
TESTICULAR CANCER - most common cancer in males ages 15-34, but rare (5.4 per 100,000 males)
--> Current recommendations by USPSTF: Screening not recommended (small to no benefit due to rarity AND high cure rate)
--> Symptoms: Lump or enlarged testicle, heaviness sensation in the scrotum, dull ache in groin, scrotal or low back pain.
THYROID CANCER - on the rise since 1970's (many postulated reasons), however 5-year survivall has significantly improved
--> Current recommendations by USPSTF: Screening not recommended (rare and no significant change in outcome with screening)
--> Most cases have a good prognosis (5-year survivall rate overall is 98.1%)
--> Types of thyroid cancer: Papillary (most common), Follicular, Medullalry, Hurthle cell, and Anaplastic (least common)
--> Symptoms: Lump/mass in neck, feeling of neck tightness, difficulty with speaking and/or swallowing, neck pain
DIABETES (Elevated blood sugars due to inadequate insulin levels OR inadequate insulin sensitivity)
- How is this accomplished? Fasting glucose, A1c level, and/or an oral glucose tolerance test (OGTT).
POSITIVE RESULT: Fasting blood sugar ≥ 126, A1c ≥ 6.5%, or 2-hour post-load glucose level ≥ 200
- Who is this screening for? The USPSTF and AAFP agree that:
1) Individuals aged 40-70 who are overweight (BMI >25) or obese (BMI ≥ 30) should be screened
2) Pregnant women at 24 weeks gestational age should be screened using an oral glucose test
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